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What is a Dorsal Wrist Ganglion Cyst?

A ganglion cyst (synovial cyst) is a fluid filled membrane that can occur around any joint in the body. Most commonly these cysts form around the dorsum of the wrist or fingers and are commonly referred to as a “Bible Cyst.” Ganglion cysts are not limited to any specific location as they can occur near any joint in the body, commonly in the back of the knee (Baker’s Cyst) and in the foot. Ganglion cysts are caused when normal joint fluid leaks out of the joint capsule due to a capsular injury (sprain) or due to a weakened portion of the capsule from overuse.

Causes

  • Fall onto an outstretched hand or arm resulting in a sprain of the wrist
  • Repetitive wrist motion; often associated with lifting and playing instruments requiring a bow
  • Repetitive wrist impact; seen in sports similar to gymnastics, tumbling, acrobatics, and football

Signs and Symptoms

  • Pain in the dorsum (back) of the wrist
  • Increased pain with palpation
  • Pain with weight bearing on an extended wrist (push-up position)
  • Obvious fluid filled mass, made more noticeable with wrist flexion

Treatment

Wrist ganglion cysts will many times rupture on their own due to continued pressure to this area from activity approximately 60% of the time.  This is a normal and safe occurrence that can lead to temporary resolution of pain and other symptoms.  Because the lining of this fluid filled membrane still remains, fluid will once again return bringing on a return of symptoms.  Aspirations (draining of fluid via a needle) can be another alternative to remove the fluid and a corticosteroid can be injected into the cyst. This again can lead to recurrence of the ganglion cyst in about 50% of cases.  If recurrence continues, surgical intervention through arthroscopy or a mini-open procedure can be done to remove the fluid as well as remove the lining of the membrane. This results in a better overall outcome with recurrence in 10-40% of cases.

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